Inside a crack house, Tommy Guess sat in the corner. He pulled out a needle and began preparing to shoot up.

Some of the people had been there for three days smoking crack, but they called him crazy for shooting up.

After shooting up, he overdosed in front of the 20 people inside. When he woke up an hour later, almost all of the people were gone.

“My first thought was, ‘Man where do I get some more of that?’ ” he said. “That was some good stuff. There were only two people left inside and they lived there and they were just praying I woke up.”

More than likely, the owners would not have called the cops or taken him to a hospital. They would have thrown him out back or in the dumpster

While he was out, he had been robbed, and he wanted more dope. He scrounged around and found a little, but he didn’t have a needle.

He remembered he had stomped a needle into the ground outside when he said he wouldn’t do drugs again. So he went outside, found the needle, cleaned some of the dirt off and shot up again.

Guess’ story shows the mental process someone afflicted with the disease of addiction goes through. When returned from the brink of death, Guess only wanted more of the drug that put him on death’s door to begin with.

The Rush

When a prescription pain pill is taken the way a doctor prescribes, it will produce some pain relief. Sometimes it will also produce a feeling of euphoria along with other side effects such as nausea, sweating and slight drowsiness.

When a prescription pain pill is snorted or injected, it produces a totally different feeling, and can quickly lead to addiction. It creates an intense high that is almost instantaneous, and what addicts call “The Rush.” “They (addicts) worship the feeling, and talk about it like it’s the most incredible experience in their life,” said Randy Jessee, senior vice president for specialty services at Frontier Health. “It always surprises me that it’s more incredible to them than two parents who love them or a spouse that loves them or children who love them.”

Addiction is a silent disease that affects millions of Americans every year. There are very few warning signs when a person starts down the path of addiction, but once the disease takes hold, it’s obvious.

Alcohol addiction was formally classified as a disease in 1966 by the American Medical Association. Drug addiction was classified as a disease by the AMA in 1974.

Addiction is formally defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

Guess understands relapsing. He tried three times to get clean, but the first two times he found himself back on drugs, even after extended periods of abstinence.

The first time, he didn’t take recovery seriously and doesn’t remember a whole lot about it. The second time, he wanted to get clean.

He stayed at Magnolia Ridge for 28 days, and when he got out he did all the right things. He stayed clean for 10 months and even managed to get a job at Magnolia Ridge. He thought things were going pretty good.

“I quit worrying about myself and started worrying about everyone else,” he said. “I got in a relationship with a girl who just got out of rehab, which I knew was a mistake.”

She started doing drugs again, and he started buying her pills just to keep her around. Eventually, he started doing drugs with her and then kicked her out because he couldn’t afford to pay for drugs for both of them.

Science of addiction

Addiction is treated like a disease now, but it has not always been that way. For a long time, people who were addicted to drugs were considered to be morally flawed or lacking in willpower, according to the National Institute on Drug Abuse (NIDA). Even today some schools of thought believe addiction to drugs is a struggle with willpower and not a medical disease.

Scientists have proven addiction is a brain disease and affects the brain in the same way heart disease affects the heart.

When an illegal drug enters the brain, most affect the central nervous system, according to Jessee. The drug or drugs flood the brain with dopamine.

Dopamine is a neurotransmitter in the brain which is present in regions that regulate movement, emotion, cognition, motivation and feelings of pleasure. Dopamine also rewards our natural behaviors, like eating, with a feeling of pleasure and teaches us to repeat the behaviors without even thinking about it.

When a prescription drug is ingested, it can release two to 10 times more dopamine than natural rewards do, according to NIDA. When a drug is injected, snorted or smoked, the dopamine is released almost instantly and the feeling lasts much longer than natural rewards, like eating and sex.

Because so much dopamine is released and it has such strong effects on the pleasure circuits of the brain, it dwarfs the pleasure felt by natural rewards and strongly motivates people to take drugs again and again.

Another issue in prescription drug abuse is the eventual lack of naturally occurring dopamine.

“Dopamine is produced naturally and then you take a substance that produces a lot of dopamine,” Jesses said. “After a while, the body says not to produce any more dopamine. So now an addict needs more dopamine just to feel normal.”

Eventually, an addict will feel lifeless, flat, depressed and unable to enjoy things that previously brought them pleasure. So in order to bring their dopamine function back to normal levels, addicts need to take drugs, but if they want to feel “The Rush” again, they have to take larger amounts of the drugs. This is known as tolerance, according to NIDA.

What can lead to addiction?

Many factors can lead to addiction. Scientists have not been able to figure out what exactly will drive a person to addiction, but a number of factors could contribute. Environmental factors such as the home environment and peer pressure have been linked to addiction, and other factors such as early use, genetics, mental illness and exposure to physical or sexual abuse have also been linked to addiction.

Some of those factors are highly visible throughout the central Appalachian region, which runs from Ohio to the Tennessee-Georgia border.

Poverty and high levels of disability plague this region, and because of the persistence of these issues and other conditions found throughout the region, it caused people in this area to not have hope, Jessee said. When hope was lost, it in turn produced a lower level of functioning. It has also led to higher stress for individuals and when stress goes up and people feel no control over their lives, they turn to drugs for self-medication, Jessee said.

“When you are in a drug-taking culture and you have a low status in society, it makes a major impact,” he said.

Abuse and addiction is also very costly to Americans. When combining the costs of the medical, economic, criminal and social impact, Americans spend half a trillion dollars every year on addiction.

Addiction is also a concern for young people. Jessee said if a young person identifies most closely with parental values, they will be less likely to abuse prescription drugs, but if a young person identifies most closely with the values of their peers, then they would be more likely to use and abuse drugs.

Guss probably identifies more closely with his peers. He was raised by his grandparents since he was 1-year old. His mother came back into his life when he was 10 or 11 and would take him to a bar, where he identified partying with good feelings.

He later found out his stepfather grew marijuana, so he started stealing it to fit in with his friends. Then to feel more accepted, he started selling it at school where he was eventually busted with it.

He gets along with everybody and it was that way when he was growing up, but he said he felt more accepted with the people who liked to party.

Jessee said the family model in this area and all over the country has eroded and parents are spending less time with their kids, which allows children to take up the value system of their peers.

Guess still struggles every day with his disease. He says he has to wake up and decide to be clean every day. It is hard for him because his own body tells him he is OK.

“It’s the only disease that tells me I don’t have a disease,” he said. “Once you become addicted, it’s incredible what you will do.”